Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
Oral lichen planus (OLP) and oral lichenoid reaction (OLR) are clinically and histopathologically similar diseases. Whereas OLP is a consequence of T cell mediated autoinflammatory process to a still unknown antigen, OLR might be caused by drugs, dental restorative
materials and dental plaque. Pubmed was searched and 24 publications published over the last three years regarding etiology, diagnosis and malignant alteration were included in this study. Patients with OLR who have amalgam fillings near lesions should have them replaced, i.e. when possible they should be referred to patch test, as well as when drug-induced OLR are suspected. OLR lesions
induced by drugs should disappear when the offending drug has been discontinued. Histology finding in OLR consists of more eosinophils, plasma cells and granulocytes in comparison to OLP lesions. Furthermore, OLP lesions showed more p53, bcl-2 and COX-2 positivity when compared to OLR. OLP is characterized by infiltration, atrophic epithelium, rete pegs and Max Joseph spaces, while deep infiltration into connective tissue and hyperkeratosis were the criteria for making the diagnosis of OLR. The number of degranulated mastocytes in the reticular layer, as well as the number of capillaries was higher in OLR in comparison to OLP. It seems that OLR are more prone to malignant alteration in comparison to OLP.Oralni lihen planus (OLP) i oralna lihenoidna reakcija (OLR) su dvije klinički i patohistološki slične bolesti. OLP je posljedica autoimunog procesa koji je posredovan T limfocitima na još uvijek nepoznati antigen, a OLR može biti uzrokovana lijekovima, dentalnim materijalima i dentalnim plakom. Cilj je ovoga preglednog rada bio istražiti Pubmed te su uključena 24 rada koja su publicirana u posljednje tri godine, a s obzirom na etiologiju, dijagnostiku i malignu alteraciju ovih bolesti. Oboljeli od OLR koji u blizini lezija imaju amalgame trebaju ih zamijeniti kompozitnim ispunima, odnosno
kad je moguće treba ih uputiti na patch test, kao i onda kada se sumnja da je OLR uzrokovana lijekovima. OLR uzrokovane lijekovima trebale bi se povući kada osoba prestane uzimati suspektni lijek. Patohistološki nalaz u OLR se sastoji od više eozinofila, plazma stanica i granulocita u usporedbi s lezijama kod OLP. Nadalje, lezije OLP imaju više pozitivnih nalaza p53, bcl-2 i COX-2 u usporedbi s lezijama OLR. OLP obilježava infiltracija, atrofični epitel, zupci pile i Max Josephovi prostori, dok OLR karakterizira dublja infiltracija u vezivno tkivo i hiperkeratoza. Broj degranuliranih mastocita u retikularnom sloju, kao i broj kapilara je veći u OLR u usporedbi s OLP. Čini se kako su OLR sklonije malignoj alteraciji u odnosu na OLP
